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word cloud: Human Health, Global Warming, Sea Level Rise, Climate Change, Infectious Disease, earth,weather, desert Disaster Research Response (DR2) Resources Portal
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Oregon State University Chemical Exposure Disaster Questionnaire

PhenX URL:
Resource Type:
Survey/Questionnaire
Contact:
Diana Rohlman
Availability:
Publicly Available, No Cost
Date Published:
09/01/2017
Date Record Updated:
03/02/2022
Description:
The Oregon State University Superfund Research Program and the Pacific Northwest Center for Translational Environmental Health are focused on chemical exposures before, during and after disasters. The Centers developed a broad Disaster Protocol, enabling rapid responses to disasters. In the case of Hurricane Harvey, using the pre-positioned protocol, researchers were able to obtain project-specific human subjects ethical approval and initiate data collection within three weeks of Harvey making landfall in Houston. The questionnaire includes virtual consent and assent, consent to receive individual results from the study, and evaluates informed consent via questions gauging comprehension of study activities and types of data being collected. Modules included in the survey: i) Demographics; ii) Exposure History specific to flooding; iii) Environmental Health; iv) Occupational History, using elements sourced from the Disaster Response Research (DR2) platform. Oregon State University Chemical Exposure Disaster Study Protocol Data Dictionary: https://disasterinfo.nlm.nih.gov/content/files/Oregon%20State%20University%20Chemical%20Exposure%20Disaster%20Data%20Dictionary.xlsx Assent statement template: https://disasterinfo.nlm.nih.gov/content/files/OSU%20Chemical%20Exposure%20Disaster%20Assent%20Template.docx Chemical Exposure Consent Template: https://disasterinfo.nlm.nih.gov/content/files/OSU%20Chemical%20Exposure%20Disaster%20Consent%20Template.docx The associated protocol can be found: https://dr2.nlm.nih.gov/search/?q=24238
Content Adapted From:
ACE Toolkit. General Survey Module G: Emergency Response. https://www.atsdr.cdc.gov/ntsip/ace_toolkit.html Question 22 Question 23b Question 23c Adapted from the NIOSH Deepwater Horizon Roster Form, Gulf Coast Oil Spill Initial Survey. https://www.nrt.org/sites/2/files/ERHMS_Final_060512.pdf (Page 117) Question 23 Question 48-50 Community Assessment for Public Health Emergency Response (CASPER): Appendix B: Question Bank https://www.cdc.gov/disasters/surveillance/pdf/casper_toolkit_version_2_0_508_compliant.pdf Question 24a-d Question 31-32 Question 35 Question 37 ATSDR Exposure Form: https://www.atsdr.cdc.gov/csem/exphistory/docs/CSEMExposHist-26-29.pdf Question 45-46 WTC Health Registry Hurricane Sandy Survey http://www.nyc.gov/html/doh/wtc/downloads/pdf/registry/wtchr-sandy-survey.pdf Question 24e-f Question 25-30 Question 33-34 Adapted Question 36a-c o Question 42 o Question 44 o Question 49 o Question 51 o Adapted Question 53

Additional Descriptors

  • Administration Mode:
  • In-Person Interview, Online or Mobile App
    • Administration Time:
    • 1-15
      • Language:
      • English
        • Number of Survey Questions :
        • 51-74
        • Resource Type:
        • Survey/Questionnaire
          • Study Population:
          • Age
            • Age: Adult, Child
              • Children: Adolescent or Teen
          • Event Type:
          • Chemical, Contamination or Release Event
            • Exposure Agent:
            • Chemical Agent

              Related Resources

              Data Dictionary
              Oregon State University Chemical Exposure Disaster Study Protocol Data Dictionary

              Consent Form
              OSU Chemical Exposure Disaster Assent Template
              OSU Chemical Exposure Disaster Consent Template

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              Last Reviewed: December 05, 2024